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NPI Code Detail

MEDICARE: MS. GLENDA D ODEN RD, CDE, LDN

MEDICARE: MS. GLENDA D ODEN RD, CDE, LDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133VN1006XMetabolic Nutrition Registered Dietitian0000000664TN
2133VN1006XMetabolic Nutrition Registered DietitianD1416MS
3133VN1201XObesity and Weight Management Nutrition Registered Dietitian164.009143IL

General Provider Information

NPI Number : 1538351200
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. GLENDA D ODEN RD, CDE, LDN
Provider Business Mailing Address
First Line : 4259 S BERKELEY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60653-3030
Country : US
Telephone Number : 773-268-7600
Fax Number : 773-268-1480
Provider Business Practice Location Address
First Line : 4259 S BERKELEY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60653-3030
Country : US
Telephone Number : 773-268-7600
Fax Number : 773-268-1480
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2007
Last Update Date : 07/14/2023

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